Do People Choose to Be Obese? Are you sure?
We live in a culture that continually looks, judges and comments on the human body. Of all bodies, the fat body is most easily stigmatised and misrepresented. But have we ever stepped back and actually examined what it means to be obese?
Obesity remains believed by most individuals to be a question of poor choices or lack of willpower. In reality, every body carries a full and complex history of everyday battles, trauma, genetics, social and environmental circumstances. Obesity is not something one does poorly. It's something that should be listened to, respected and treated with compassion.
This is not a message to the elite, those who are already aware of the burden of discrimination, but to the surface judgmenters. Reduced to physical looks, it is unfair. We can only restore the dignity to every individual regardless of how he or she appears by overcoming prejudice.
Obesity: it is a chronic disease, not a personal choice
The World Health Organisation (WHO) now recognises obesity as a chronic disease. Obesity is a complex condition which is an abnormal growth in body fat with severe consequences for physical and mental health.
It is not an issue of willpower or conduct. Obesity is genetically, environmentally, psychologically and metabolically based. To continue to consider it a matter of personal weakness is to disregard scientific fact and to disregard the experience of millions of people.
Treatment for obesity has to be multidisciplinary: medical intervention, psychological counseling, diet education and public policies that are inclusive. There is no judgment-based solution which can replace understanding and respect.
Sources: World Health Organization – Obesity and Overweight (https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight), American Medical Association – Obesity as a Disease, National Institute of Diabetes and Digestive and Kidney Diseases – Obesity.
Deflating the myth of binge eating: obesity is much more than this
The idea that obesity is the result of 'over-eating' is a simplism which is not helpful. While diet and exercise play a significant role in describing the cause of the condition, they are insufficient to account for it on their own.
Obesity is the result of a multiplex system of factors: genetics, neurobiology, hormones, emotional stress, social and economic conditions. Behind every obese person there is a unique circumstance that has nothing to do with calorie mathematics.
Stereotyping this complexity traps people in damaging stereotypes and denies them access to effective treatment. Science-based and empathic response is the only effective form to directly address the problem.
Sources: Harvard T.H. Chan School of Public Health – The Obesity Prevention Source, NIH – Health Information on Obesity, Endocrine Society – Obesity Resources.
Hormones and genetics: when our body makes the choice for us
Genetic predisposition plays a vital role in obesity onset. People have a greater tendency to accumulate body fat regardless of diet or physical level. Genetic elements can control elements of hunger and satiety, metabolism, and fat distribution.
The hormonal system also has a crucial role to play. Imbalances in hormone production and sensitivity to such hormones as leptin, insulin, ghrelin and cortisol can make weight control enormously more difficult.
It is not, therefore, the case of 'laziness' or 'poor motivation', but of a body responding to deeply ingrained mechanisms over which many people have little or no control.
Sources: American Society for Nutrition – Genetics and Obesity, Nature Reviews Endocrinology – Hormonal Regulation of Body Weight, Journal of Clinical Investigation – Genetic Causes of Obesity.
The obesogenic environment: when society promotes disease
The world we live in has a profound influence on what we eat and how active we are. Our community, economic system and food choices unintentionally promote weight gain. This is termed the 'obesogenic environment'.
Physical space for activity is a luxury in the majority of urban environments, while ultra-processed, high-calorie foods are cheap, readily accessible and highly promoted. The most economically disadvantaged communities have reduced access to healthy options and are more exposed to them.
Here, it is not correct to talk about 'bad choices'. It is a question of lack of equal opportunities, not of freedom of choice. Fighting obesity requires public policy, environmental action and structural change in urban and food systems.
Sources: The Lancet Commission on the Global Syndemic of Obesity, Obesity Reviews – Built Environment and Obesity, American Journal of Public Health – Social Determinants of Obesity.
Obesity and mental illness: the invisible burden of discrimination
Obesity does not only hit physical health but also leaves a profound mark on psychological well-being. Social discrimination, stigma and constant judgment build an emotionally toxic environment. Obese people are often mocked, blamed and excluded.
This social pressure has dire consequences: worry, depression, low self-esteem and eating disorders, such as emotional or compulsive eating. In most cases, the weight of judgment drives body weight, heightening suffering and making recovery more difficult.
Obesity is not a disease but also a social issue. Omission of the psychological damage means causing a cycle of exclusion and aggravation of the disease.
References: Psychological Bulletin – Weight Stigma and Mental Health, Obesity – Weight Discrimination and Psychological Stress, Appetite – Emotional Eating and Social Pressure.
Obesity requires a coordinated, individualized strategy
Obesity is most appropriately managed using simple solutions such as fad diets or excessive exercise, and this is both ineffective and perhaps harmful. Obesity must be managed by a multidisciplinary team of practitioners on an individualized basis with medical, nutritional and psychological assistance.
Effective protocols include clinical treatment, behavior treatment, drug treatment if needed and, in the most severe cases, bariatric surgery. No treatment exists, however, that can work without the active cooperation of the subject in a empathetic and not a judging environment.
Shame cannot treat obesity. It must be treated with competence, listening and a health system understanding the complexity of the disease.
Sources: The Lancet Diabetes & Endocrinology – Obesity Management Strategies, JAMA – Comprehensive Obesity Care, WHO – Managing the Global Epidemic of Obesity.
The silent pandemic: the frightening statistics of global obesity
More than one billion people worldwide are obese, 650 million adults and over 120 million children, according to the latest figures from the World Health Organisation. It is a stealthy epidemic, growing exponentially in industrialised countries but increasingly also in developing countries.
Obesity is not only an issue of extreme cases. Even mild over-weight has the potential to significantly increase the risk of diseases such as type 2 diabetes, high blood pressure and certain types of cancer. The epidemic is something that affects everyone, at all ages, both sexes and geographic regions.
The statistics confirm that this is not a personal problem, but rather an international disease crisis.
Sources: World Health Organization – Obesity and Overweight, The Lancet – Global Trends in Obesity, UNICEF – Childhood Obesity Statistics.
Comorbidities of obesity: the diseases hidden behind weight
Obesity is most often a precursor to many other serious chronic diseases. The most common comorbidities are:
- Type 2 diabetes
- High blood pressure
- Cardiovascular disease (heart attack, stroke)
- Sleep apnoea
- Specific cancers (breast, colon, liver)
- Osteoarthritis and joint diseases
Moreover, psychological distress should not be underplayed: most overweight individuals feel stigmatized, embarrassed and ill at ease that impair their quality of life as much as their body state.
They are not only statistics. They are daily lives that significantly affect public health and health expenses.
Sources: Obesity Reviews – Obesity-Related Comorbidities, New England Journal of Medicine – Obesity and Mortality Risk, Journal of the American College of Cardiology – Obesity and Cardiovascular Disease.
Obesity and social justice: when the body becomes an obstacle
Apart from its clinical consequences, obesity also has substantial social consequences. Obese people are discriminated against in the workplace, at school, in the media and even in the healthcare system. They receive inferior care and are pre-judged before they get an opportunity to be heard.
This organized exclusion restricts access to education, work and health, rendering the individual poor, and locking them into a cycle of misfortune and disadvantage. In this regard, weight too becomes a determinant of social injustice.
Combating obesity also means combating the structural disparities that perpetuate it. Inclusion, respect and eradicating prejudice must be part of any prevention and treatment program.
Sources: American Journal of Public Health – Weight-Based Discrimination, Obesity Reviews – Social Consequences of Obesity, Journal of Obesity – Weight Stigma and Health Inequities.
Childhood obesity: an emergency that compromises the future
No age group is exempt from the effects of obesity. Obese children and teenagers not only have the immediate physical risks, but are also likely to develop long-term conditions in adulthood, such as type 2 diabetes, high blood pressure and musculoskeletal disorders.
In addition, there is also a horrible psychological impact: bullying, isolation, low self-esteem and eating disorders are frequently associated with childhood obesity. Family, school and virtual environment usually create the issue and not solve it.
Prevention starts early with the engagement of families, schools, health care providers and public policy. Fostering nutrition education and physical activity from an early age is a central strategy for breaking the cycle of overweight in the generations to come.
Sources: World Health Organization – Childhood Obesity, Pediatrics – Psychological Impact of Obesity in Youth, The Lancet Child & Adolescent Health – Early Interventions for Obesity.
The power of words: how they can harm (or help)
The words we use to explain obesity do have an impact on individuals who live with the condition. Words such as 'fat', 'lazy' and 'undisciplined' are not only misleading, but hurtful. Stigmatising language supports prejudice and discourages individuals from seeing a doctor.
With respectful words that address the person, not the illness, we need to be mindful. We talk of 'people with obesity', rather than 'obese individuals'. That slight adjustment makes the world of difference: viewing the person first, then the diagnosis.
Even in medical and institutional communications, empathy-sensitive language is at the heart of improving access to care and reducing stigma.
References: Obesity – Person-First Language in Obesity Care, AMA Journal of Ethics – Language Matters in Medical Discourse, Health Communication – Impact of Stigmatising Language on Public Health.
Mindful eating: a balanced, non-restrictive approach
The best way to fight obesity may not be harsh calorie restriction but education in mindful eating. Mindful eating promotes a balanced relationship with food, listening to the body and managing emotions.
Severe diets lead only to frustration and cycles of weight gain and loss (yo-yo effect). A long-term nutritional plan, along with psychological support, brings lasting change and improves long-term health.
We need to stop demonizing certain foods and establish a system of eating based on wellness rather than compulsive control.
Sources: Journal of Nutrition Education and Behaviour – Mindful Eating and Obesity, International Journal of Obesity – Dieting and Weight Cycling, Nutrition Reviews – Behavioural Approaches in Obesity Treatment.
The role of movement: exercise as a tool of health, not punishment
Physical exercise is a key to metabolic, cardiovascular and mental health. But it has to be done as a fuel supply rather than punishment for what you've eaten or your weight.
Obese individuals avoid exercise out of fear of criticism, hurt or frustration. Proper exercise has to be made easily available, flexible and non-competitive.
Movement can and should be a natural part of daily life, strings-free and without remorse. The goal is not just to be thinner, but to thrive.
Sources: British Journal of Sports Medicine – Physical Activity in Obesity Management, ACSM – Exercise Guidelines for Obese Adults, Obesity Reviews – Physical Activity and Psychological Benefits.
Towards an inclusive society: changing culture, not just bodies
Tackling obesity is not a matter of changing bodies to fit a standard. It is about changing a society that judges them. A healthy society does not measure individuals' value by their weight, but perceives the rights, dignity and possibilities of all people, without exception.
Institutions, the media, schools and workplaces can all contribute to providing an environment which is stigma-free and non-discriminatory. This is not only a health goal, but a moral one.
Promoting a non-discriminatory view of obesity is the first step towards creating a more just, better educated and more empathetic society.
References: Journal of Health Psychology – Weight Bias and Social Inclusion, International Journal of Environmental Research and Public Health – Anti-Stigma Interventions, Obesity Society – Creating a Weight Inclusive Society.
Obesity in the medical environment: a matter of access, not diagnosis
The obese are also often confronted not just with their illness, but with an ineffective or prejudiced medical system. Many members of the medical community, consciously or unconsciously, acquire prejudiced attitudes that interfere with communication and compliance with treatment.
Consultations tend to be wasteful advice on 'weight loss', overlooking the plurality of the clinical presentation and the aetiology of the condition. This discourages patients, lowers confidence in the system, and delays interventions that are needed.
Trained health professionals in obesity as a chronic disease and promoting inclusive clinical environments will be required to guarantee equal access to care.
References: Obesity Research & Clinical Practice – Weight Bias in Healthcare, Journal of General Internal Medicine – Discrimination and Medical Avoidance, The Obesity Society – Healthcare Provider Training.
Medication and surgery: useful tools, not magic bullets
Some individuals find that diet and exercise are insufficient to control obesity. In their situation, treatment may involve the use of authorized medications or bariatric surgery as an acceptable treatment, under the close care of a health professional.
These practices are not 'quick fixes' or cheats: they require a well-planned programme, psychological therapy and regular clinical supervision. Properly managed, they can do much to enhance metabolic health and well-being.
Let us move away from the moralistic approach that sees the use of drug treatment or surgery as a personal failing.
Sources: New England Journal of Medicine – Pharmacological Management of Obesity, Lancet Diabetes & Endocrinology – Bariatric Surgery Outcomes, Endocrine Reviews – Clinical Guidelines for Obesity Treatment.
Public policy and prevention: changing the system, not just the individual
Obesity will not be dealt with in surgeries of doctors. Political and social action is needed to change the environment within which we live: control of advertising unhealthy food, charging tax on sugary drinks, rewarding physical activity, town planning promoting activity, and school nutrition education.
Interventions are needed at an individual level, but this will be insufficient if the environment remains unsupportive. Prevention must work with system, coordinated, and evidence-based approaches.
Governments, health facilities and the private sector should act responsibly and proactively.
Sources: WHO – Best Buys for Noncommunicable Disease Prevention, Public Health Nutrition – Policy Interventions and Obesity, OECD – Obesity Update and Economic Impact.
Combating stigma: obesity does not determine an individual's value
Stigma on weight is likely to be the most ingrained and least apparent discrimination. It permeates every aspect: social relationships, work, school and health. Overweight people are often forced to justify themselves, hide or endure discriminatory behavior.
It should be strongly asserted that the morality, discipline or intelligence of a person is not determined by their weight. The worth of an individual cannot be reduced to a number in a scale.
Making a culture of health and inclusion means actively fighting prejudice and building a fairer and more human narrative.
Sources: International Journal of Obesity – Weight Stigma and Health Outcomes, Social Science & Medicine – Internalised Weight Bias, Journal of Applied Psychology – Discrimination Based on Body Weight.
Obesity: from a private problem to a collective responsibility
Obesity is too often viewed as a family issue, isolated at home. But scientific proof and societal data show us that it is an issue that affects the community in general.
The education, environment, economy, mental health and social justice are all intertwined with the issue of body weight. So if the battle against obesity is to be successful, it must not be focused on merely 'curing' individual behavior, but transforming the systems that generate inequality and illness.
There has to be institutional and systemic change. That is only when we shall be able to build a society that does not cure the symptom but heals the cause of the disease.
Sources: The Lancet Commission on Obesity – A Systems Approach, Global Health Action – Obesity as a Collective Responsibility, BMJ – Public Health and Structural Change.
